What are we doing here...

I worked as a Hospice social worker for 12 years. I went to people's homes and witnessed their final breaths, heard final wishes, heard unresolved heart aches that sometimes went with them if not released before leaving. When I first started working in this field, I thought somehow I might know something about life and be able to counsel people. I wanted to be this neat little package of goodies that entered their lives. I found out real quick that counselling a traveler who was ending every reality known to them and me goes beyond the comfort zone of treating grief pathology with the intellectual, professional detachment usually used with a "patient".



Welcome aboard to the world of countertransference. A psychological term, defined in a book called "When Professionals Weep", published by Taylor and Francis Group as "... a concept that actually beckons the helper to look at their humanness in the face of dying, death, and bereavement, rather than avoiding it". This description fits the context of End-of-Life Care and a professional's powerful reaction to their work. Unlike the days of Freud where this reaction was considered an obstacle, it is now considered a natural, appropriate and healthy therapeutic tool and is the basis for empathy and a deeper understanding of ourselves and the patient.

As a social worker in Hospice, I was graced with being invited into homes to witness, share, listen and assist. Nurses have a easier way in as they are tending to symptom management and pain control and are necessary. People would have to like me to let me in because it was their home, their domain and if you were anything other than a "comfort" or of some use, you were kicked out. So I offered myself, my willingness to interact and my emotional response became a tool to understand and explore their world while being mindful and aware of my responses that could potentially interfere with their dying process. I learned to believe in the person and their ability to find purpose, to continue living even though they were being forced out of their physical body because of an illness. Right here you can see that I believe in the soul, our inner self and that our bodies are containers of that spiritual self. That belief is mine and I am aware of it; it is not something I ever tried to foist on a patient but I would explore their beliefs if allowed. I learned to focus, to listen and not turn away, not distract, not avoid, not deny, and not abandon the person when I became uncomfortable by what I saw and heard. I believed that each person had a right to do their dying business according to their individualistic style and yes I did hope the person could be graced with dignity, integrity, hope and even possibly with peace. I say possibly because I have witnessed the opposite, the inconsolable, broken hearted, angry, despairing death also. These are the ones that test your boundaries the most. Sometimes life beliefs, attitudes and emotional states culminate when you are close to death and there is not time to resolve all of that which may have been dormant somewhere in that person's psyche and surfaces at this vulnerability time. This is where I felt my work was at. This is where I would ask the dying what they needed to do or have done before they died (in case they needed permission to ask). Sometimes it was as simple/difficult as locating a son or daughter who for their own reasons had nothing to do with the patient. When I made the call, sometimes it meant reunion, forgiveness, completion and sometimes I got to hear the harshness of words like, "I hate that fucker, he raped me when I was young". Right there, I had to check any countertransference I had going on about molestation and move on to help the patient to identify and perhaps seek self-forgiveness with help from myself and our Spiritual team.



So many times I watched the nurse, bath aide, or volunteer try to fix the dying, try to do home remedy psychology on the person. I had a big problem with a particularly loud, insecure,"Praise the Lord" nurse I worked with who was convinced her religious beliefs were the way for people to find peace and resolution before they died. My theory was she kept up all that noisy religious stuff so she could not hear or feel her own loneliness, fear, and avoid recognition of how harmful she could be to a vulnerable person who was too weak to fend her off. Countertransference gone berserk. That is where I would enter the picture by advocating for folks and reminding staff of boundaries, inappropriate behavior on their parts, etc. I was not the most popular with the "less mindful" workers who ultimately made themselves feel better by playing hero. This nurse was a conscientious experienced nurse albeit manic and to me she had her place with the less cognitively inclined population who didn't give a damn what she believed or who she praised. I remember we kept her working in the nursing homes because she was given the boot quite frequently from the homes. So, the Hospice workers are not perfect and choose the work for many many different reasons and no matter who or what they are, they enter an arena, the dying arena that most people avoid. We had to face our mortality on a daily basis not when we had a moment to ponder the meaning of living and dying and so we had to have our countertransference issues in check at all times.

I will be sharing vignettes of what I witnessed and experienced and learned in this profession in this blog.

2010 Rozanna Landavazo